Pulmonary Mucormycosis Presenting as an Endobronchial Lesion

Husari, Ahmad; Jensen, William A.; Kirsch, Carl M.; Campagna, Anthony C.; Kagawa, Frank T.; Hamed, Kamal; Azzi, Raymond L.; Stevens, David A.

doi:10.1378/chest.106.6.1889

Cited by 36 publications

(31 citation statements)

References 10 publications

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“…Invasive fungal infection can also present as an endobronchial mass. 3 Simultaneous tracheal and laryngeal cartilage damage can occur. 3 Isolated tracheal mucormycosis is very rare (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Tracheal Mucormycosis Pneumonia: A Rare Clinical Presentation

Mohindra¹,

Gupta²,

Gupta³

et al. 2014

Respir Care

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This article reports an unusual case of tracheal mucormycosis following H1N1 pneumonia and reviews previously reported cases. A 40-y-old female with a 5-y history of diabetes mellitus, adequately controlled by oral hypoglycemic agents, developed tracheal mucormycosis after successful treatment for H1N1 pneumonia. The condition was diagnosed during workup for decannulation due to subglottic and upper tracheal obstruction by necrotic chewing gum-like tissue and cartilage. The patient was managed successfully by treatment with amphotericin B and surgical intervention in the form of laryngofissure and Montgomery tube placement. A review of the literature revealed only 5 previously reported cases of tracheal mucormycosis. A high degree of suspicion, early endoscopy and biopsy, histopathological evidence of the infection, and early institution of therapy are the keys to successful outcome.

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Section: Discussionmentioning

confidence: 99%

“…3 Simultaneous tracheal and laryngeal cartilage damage can occur. 3 Isolated tracheal mucormycosis is very rare (Table 1). Anand et al 9 presented a case of laryngeal mucormycosis limited to vocal cords as a vocal polyp.…”

Section: Discussionmentioning

confidence: 99%

Tracheal Mucormycosis Pneumonia: A Rare Clinical Presentation

Mohindra¹,

Gupta²,

Gupta³

et al. 2014

Respir Care

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“…Of the 17 cases of primary endobronchial involvement described in the literature, 14 (82%) were in diabetics. 1,2,6,7 In our patient, the mean random serum glucose level was 125 mg/dl measured over a 29-day period prior to transplant and 178 mg/dl measured over a 23 day period post transplant. The elevated blood glucose is likely due to the routine use of solumedrol given to our patients starting at post-transplant day +5.…”

Section: Rhizopus Presenting As An Endobronchial Obstruction Followinmentioning

confidence: 65%

Rhizopus presenting as an endobronchial obstruction following bone marrow transplant

Maddox

Long

Vredenburgh

et al. 2001

Bone Marrow Transplant

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“…The airways involved are typically oedematous and necrotic, or lesions with an appearance suggestive of a bronchial adenoma. HUSARI et al [7] postulated that a submucosal, invasive fungal infection caused a submucosal abscess, which presented as an endobronchial mass. Simultaneously, it may lead to tracheal cartilage damage as in the unusual case presented herein, which is extremely rare in pulmonary mucormycosis and has not been reported previously.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory pseudotumoural endotracheal mucormycosis with cartilage damage

Luo¹,

Cheng²,

Zhu³

et al. 2009

European Respiratory Review

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Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.KEYWORDS: Cartilage damage, dyspnoea, mucormycosis, tracheal stenosis M ucormycosis, also called zygomycosis, is an important opportunistic infection caused by fungus that belongs to the class Zygomycetes, which is the third most common invasive fungal infection after candidosis and aspergillosis [1]. Although the infection rate of mucormycosis is very low, patients with immunosuppression, diabetes mellitus or haematological malignancy are at the highest risk for mucormycosis. Mucorales rarely invades the trachea. Tracheal cartilage damage is extremely rare in pulmonary mucormycosis. Herein, we report an unusual case of mucormycosis in a diabetic male presenting with an endotracheal mass obstructing the trachea and cartilage damage with histological confirmation of endotracheal mucormycosis. CASE REPORTA 46-yr-old male nonsmoker was admitted to our hospital (West China Hospital, Sichuan University, Chengdu, China) because of throat discomfort, cough and expectoration of 1 month duration. Simultaneously, he had mild dyspnoea, especially during exercise. He also had type 2 diabetes, which had been diagnosed ,5 yrs previously; his diabetes had been poorly controlled by diet alone. Physical examination revealed that bilateral lung breathing sounded rough and moist rales could be heard in the left lung. Laboratory data showed that the white blood cell count was 11.82610 9 L -1 with 76.7% neutrophils and hyperglycemia (18.57 mmol?L -1 ) was observed. Blood urea nitrogen and creatinine were normal. Acid-fast bacilli smears and cultures of sputum were negative. We also excluded the possibility of HIV infection. Computed tomography of the chest and neck indicated that the tracheal wall was thickened, the cricoid cartilage was damaged and the lumen was narrow ( fig. 1). Fibreoptic bronchoscopy revealed that the upper airway mucosal was oedematus, thickened and that the lumen was narrow and funnel-shaped. A valve-like neoplasma was seen on the right wall of upper trachea ( fig. 2). Biopsies were obtained by removal of the lesion via bronchoscopy and the histological sections revealed moderate chronic inflammation in the mucosa of the upper trachea, associated with inflammatory exudates, necrosis, granulation tissue proliferation and numerous hyphae of mucormycosis. Histochemical staining indicated negative acid-fast stain, positive periodic acidSchiff, positive hexamine stain and positive mucus carmine stain. He was diagnosed with endotracheal mucormycosis with granulation formation and diabetes mellitus.Diab...

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Pulmonary Mucormycosis Presenting as an Endobronchial Lesion

Cited by 36 publications

References 10 publications

Tracheal Mucormycosis Pneumonia: A Rare Clinical Presentation

Tracheal Mucormycosis Pneumonia: A Rare Clinical Presentation

Rhizopus presenting as an endobronchial obstruction following bone marrow transplant

Inflammatory pseudotumoural endotracheal mucormycosis with cartilage damage

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